NPIMap

Organization Active NPI

Behavioral Health and Wellness

  • Mental Health Counselor
  • Meridian, MS
National Provider Identifier
1487065587
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MCLPC1329 Issued in MS
Legal business name
BEHAVIORAL HEALTH AND WELLNESS
Practice address
4805 Poplar Springs Dr
Suite a
Meridian, MS 39305-2625
Phone
(601) 693-1234
NPI assigned
May 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ricardo Fraga, LPC
Title
Owner
Phone
(601) 693-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X MCLPC1329 MS Primary

Addresses

Primary practice location

4805 Poplar Springs Dr
Suite a
Meridian, MS 39305-2625

Mailing address

4805 Poplar Springs Dr
Suite a
Meridian, MS 39305-2625
Phone (601) 693-1234

National Provider Directory

National Provider Directory

Locations

4805 Poplar Springs Dr
Ste A
Meridian, MS 39305
Phone (601) 693-1234

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1487065587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 POPLAR SPRINGS DR",
            "address_2": "SUITE A",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052625",
            "telephone_number": "601-693-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 POPLAR SPRINGS DR",
            "address_2": "SUITE A",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052625",
            "telephone_number": "601-693-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "FRAGA",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-693-1234",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "MCLPC1329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.